Provider Demographics
NPI:1326348582
Name:MERIDIAN HEALTH PLAN, INC.
Entity Type:Organization
Organization Name:MERIDIAN HEALTH PLAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-324-3701
Mailing Address - Street 1:777 WOODWARD AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:777 WOODWARD AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3536
Practice Address - Country:US
Practice Address - Phone:313-324-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAIDAN ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization